Transcript CHAPTER 11: Haemodialysis Practices

CHAPTER 11:
Haemodialysis Practices
Shahnaz Shah Firdaus Khan
Tan Chwee Choon
Rafidah Abdullah
Norleen Bt Zulkarnain Sim
Source: 21st MDTR Report 2013, NRR
Table 11.1.1: Vascular access on haemodialysis, 2004-2013
Access types
2004
2005
2006
2007
2008
n
%
n
%
n
%
n
%
n
%
Wrist AVF*
5891
72.7
6404
68.8
7798
67.2
8309
64.3
9494
61.5
BCF*
1692
20.9
2169
23.3
2855
24.6
3421
26.5
4403
28.5
BBF*
0
0
0
0
0
0
0
0
70
0.5
Graft
190
2.3
251
2.7
306
2.6
341
2.6
479
3.1
HD Catheter-cuffed
99
1.2
179
1.9
235
2
261
2
298
1.9
HD Catheter –Non Cuffed
233
2.9
305
3.3
405
3.5
582
4.5
687
4.5
TOTAL
8105
100
9308
100
11599
100
12914
100
15431
100
Access types
2009
2010
2011
2012
2013
n
%
n
%
n
%
n
%
n
%
Wrist AVF*
10668
59.7
11130
57.3
12338
55.6
13419
52.8
14628
51.3
BCF*
5246
29.3
6105
31.4
7249
32.7
8823
34.7
10008
35.1
BBF*
133
0.7
191
1
295
1.3
395
1.6
549
1.9
Graft
466
2.6
495
2.5
488
2.2
519
2
543
1.9
HD Catheter-cuffed
464
2.6
513
2.6
569
2.6
947
3.7
1225
4.3
HD Catheter –Non Cuffed
901
5
1000
5.1
1244
5.6
1306
5.1
1567
5.5
17878
100
19434
100
22183
100
25409
100
28520
100
TOTAL
*AVF = arteriovenoous fistula, BBF = Brachiobasilic fistula, BCF = brachiocephalic fistula
Source: 21st MDTR Report 2013, NRR
Table 11.1.2: Difficulties report with vascular access, 2004-2013
2004
2005
2006
2007
2008
Access difficulty
n
%
n
%
n
%
n
%
n
%
Difficulty with needle placement
255
3.4
319
3.5
394
3.5
478
3.8
417
2.8
Difficulty in obtaining desired blood
flow rate
301
4
354
3.9
356
3.1
368
2.9
420
2.8
67
0.9
58
0.6
45
0.4
57
0.5
81
0.5
No difficulties
6956
91.8
8338
91.9 10591
93
11577 92.8 14080 93.9
TOTAL
7579
100
9069
100
100
12480
Other difficulties
2009
Access difficulty
11386
2010
2011
100
14998
2012
100
2013
n
%
n
%
n
%
n
%
n
%
Difficulty with needle placement
523
3
555
2.9
473
2.2
635
2.5
539
1.9
Difficulty in obtaining desired blood
flow rate
473
2.7
437
2.3
488
2.2
581
2.3
480
1.7
Other difficulties
101
0.6
78
0.4
72
0.3
118
0.5
72
0.3
No difficulties
16489 93.8 18071 94.4 20824 95.3 23841 94.7 27348 96.2
TOTAL
17586
100
19141
100
21857
100
25175
100
28439
100
Source: 21st MDTR Report 2013, NRR
Table 11.1.3: Complications reported with vascular access,
2004-2013
Complication
Thrombosis
Bleed
Aneurysmal dilatation
Swollen limb
Access related infection, local/systemic
Distal limb ischaemia
Venous outflow obstruction
Carpal tunnel
Others
No complications
Total
Complication
Thrombosis
Bleed
Aneurysmal dilatation
Swollen limb
Access related infection, local/systemic
Distal limb ischaemia
Venous outflow obstruction
Carpal tunnel
Others
No complications
Total
2004
n
284
67
193
77
70
37
151
49
133
6895
7956
2005
%
n
%
n
3.6
289
3.2
317
0.8
73
0.8
69
2.4
179
2
246
1
84
0.9
89
0.9
63
0.7
78
0.5
35
0.4
30
1.9
170
1.9
202
0.6
55
0.6
48
1.7
109
1.2
116
86.7 8112 88.5 10153
100 9169 100 11348
2009
n
481
72
452
162
133
25
299
48
119
15874
17665
2006
%
2.7
0.4
2.6
0.9
0.8
0.1
1.7
0.3
0.7
89.9
100
2010
n
463
78
319
150
123
33
239
44
122
17601
19172
%
2.4
0.4
1.7
0.8
0.6
0.2
1.2
0.2
0.6
91.8
100
2007
2008
%
n
%
2.8
405
3.2
0.6
58
0.5
2.2
385
3.1
0.8
101
0.8
0.7
97
0.8
0.3
27
0.2
1.8
196
1.6
0.4
46
0.4
1
152
1.2
89.5 11052 88.3
100 12519 100
2011
n
491
76
397
140
127
25
270
49
142
20229
21946
%
2.2
0.3
1.8
0.6
0.6
0.1
1.2
0.2
0.6
92.2
100
n
436
76
396
98
92
31
250
48
165
13520
15112
2012
n
589
90
527
202
187
42
366
47
191
23119
25360
%
2.3
0.4
2.1
0.8
0.7
0.2
1.4
0.2
0.8
91.2
100
%
2.9
0.5
2.6
0.6
0.6
0.2
1.7
0.3
1.1
89.5
100
2013
n
513
83
402
154
177
28
337
53
185
26615
28547
%
1.8
0.3
1.4
0.5
0.6
0.1
1.2
0.2
0.6
93.2
100
Source: 21st MDTR Report 2013, NRR
Table 11.2.1: Blood flow rates in HD centers, 2004-2013
Blood flow rates
(ml/min)
<150
150-199
200-249
250-299
300-349
>=350
Total
2004
n
11
86
879
3112
2710
1020
7818
2005
%
0.1
1.1
11.2
39.8
34.7
13
100
n
7
94
814
3523
3225
1328
8991
2009
2006
%
0.1
1
9.1
39.2
35.9
14.8
100
n
5
103
923
3818
4528
1920
11297
2010
2007
2008
%
n
%
n
%
0
10
0.1
10
0.1
0.9
87
0.7
120
0.8
8.2
929
7.4
929
6.2
33.8 3821 30.5 4639 31.1
40.1 5214 41.7 6127 41.1
17
2451 19.6 3095 20.7
100 12512 100 14920 100
2011
2012
2013
Blood flow rates
(ml/min)
n
%
n
%
n
%
n
%
n
%
<150
14
0.1
16
0.1
13
0.1
15
0.1
21
0.1
150-199
126
0.7
113
0.6
120
0.6
128
0.5
155
0.6
200-249
1178
6.8
1192
6.3
1112
5.1
1109
4.5
1235
4.4
250-299
5050
28.9
5021
26.5
5341
24.7
5810
23.3
6229
22.2
300-349
7097
40.7
7721
40.8
8871
41
10512
42.2
12231
43.5
>=350
3981
22.8
4850
25.6
6167
28.5
7347
29.5
8223
29.3
Total
17446
100
18913
100
21624
100
24921
100
28094
100
Source: 21st MDTR Report 2013, NRR
Figure 11.2.1: Blood flow rates in HD centers, 2004-2013
<150 ml/min
150-199 ml/min
200-249 ml/min
250-299 ml/min
300-349 ml/min
>=350 ml/min
40
%
30
20
10
0
2004
2005
2006
2007
2008
2009
Year
2010
2011
2012
2013
Source: 21st MDTR Report 2013, NRR
Table 11.2.2: Number of HD sessions per week, 2004-2013
2004
2005
2006
2007
2008
HD sessions
per week
n
%
n
%
n
%
n
%
n
%
1
11
0.1
7
0.1
25
0.2
14
0.1
5
0
2
281
3.5
265
2.8
273
2.3
256
2
259
1.7
3
7750
96
9010
96.7
11325
97.2
12602
97.7
15058
97.9
4
30
0.4
31
0.3
34
0.3
31
0.2
61
0.4
8072
100
9313
100
11657
100
12903
100
15383
100
Total
2009
2010
2011
2012
2013
HD sessions
per week
n
%
n
%
n
%
n
%
n
%
1
6
0
9
0
6
0
33
0.1
37
0.1
2
271
1.5
309
1.6
240
1.1
369
1.4
403
1.4
3
17581
98
19089
98.1
22001
98.8
25099
98
28291
98.2
4
88
0.5
47
0.2
26
0.1
109
0.4
76
0.3
17946
100
19454
100
22273
100
25610
100
28807
100
Total
Source: 21st MDTR Report 2013, NRR
Table 11.2.3: Duration of HD, 2004-2013
Duration of HD
per session (hrs)
<=3
3.5
4
4.5
5
>5
TOTAL
Duration of HD
per session (Hrs)
<=3
3.5
4
4.5
5
5
TOTAL
2004
n
25
11
7884
106
45
3
8074
2005
%
0.3
0.1
97.6
1.3
0.6
0
100
n
31
9
9174
46
52
0
9312
2009
%
0.3
0.1
98.5
0.5
0.6
0
100
2006
n
28
6
11506
66
42
1
11649
2010
2007
%
0.2
0.1
98.8
0.6
0.4
0
100
n
37
11
12792
23
31
1
12895
2011
2008
%
0.3
0.1
99.2
0.2
0.2
0
100
n
54
10
15204
74
42
0
15384
2012
%
0.4
0.1
98.8
0.5
0.3
0
100
2013
n
%
n
%
n
%
n
%
n
%
67
25
17740
78
42
1
17953
0.4
0.1
98.8
0.4
0.2
0
100
77
36
19231
72
50
0
19466
0.4
0.2
98.8
0.4
0.3
0
100
65
10
22114
40
38
5
22272
0.3
0
99.3
0.2
0.2
0
100
115
72
25310
66
47
3
25613
0.4
0.3
98.8
0.3
0.2
0
100
123
34
28604
23
32
0
28816
0.4
0.1
99.3
0.1
0.1
0
100
Source: 21st MDTR Report 2013, NRR
Table 11.2.4: Dialyser membrane types in HD centres,
2004-2013
Dialyser membrane
2004
2005
2006
2007
2008
n
%
n
%
n
%
n
%
n
%
Modified Cellulose
1719
22.1
1974
21.8
2489
21.6
2890
22.7
3431
22.7
Regenerated Cellulose
1150
14.8
930
10.3
997
8.7
699
5.5
486
3.2
Hydrophobic/Hypdrophilic
4845
62.2
6019
66.3
7859
68.3
8984
70.7 10890 72.2
Hydrophilized copolymers
74
1
150
1.7
161
1.4
137
1.1
7788
100
9073
100 11506 100 12710 100 15093 100
TOTAL
Dialyser membrane
Modified Cellulose
Regenerated Cellulose
Hydrophobic/Hypdrophilic
Hydrophilized copolymers
TOTAL
2009
2010
2011
2012
286
1.9
2013
n
%
n
%
n
%
n
%
n
%
3246
19
3306
18.9
3706
23.4
3910
25.9
3586
14.7
418
2.5
202
1.2
60
0.4
10
0.1
46
0.2
13056 76.6 13609 77.7 11771 74.2 10886 72.2 20388 83.3
335
2
409
2.3
323
2
274
1.8
454
1.9
17055 100 17526 100 15860 100 15080 100 24474 100
Source: 21st MDTR Report 2013, NRR
Figure 11.2.4: Dialyser membrane types in HD centres,
2004-2013
Modified Cellulose
Hydrophobic/Hypdrophilic
Regenerated Cellulose
Hydrophilized copolymers
100
90
80
70
%
60
50
40
30
20
10
0
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Year
Source: 21st MDTR Report 2013, NRR
Table 11.2.5: Dialyser reuse frequency in HD centres, 2004-2013
Dialyser reuse
frequency
1
2
3
4
5
6
7
8
9
10
11
12
≥ 13
TOTAL
2004
n
42
194
192
192
806
89
808
50
1160
42
1916
458
92
6041
Dialyser reuse
frequency
1
2
3
4
5
6
7
8
9
10
11
12
≥ 13
TOTAL
2009
n
29
115
89
184
743
193
774
294
2651
61
5691
2010
99
12933
%
0.7
3.2
3.2
3.2
13.3
1.5
13.4
0.8
19.2
0.7
31.7
7.6
1.5
100
2005
n
1
81
85
137
554
44
477
46
770
12
1353
565
105
4230
%
0
1.9
2
3.2
13.1
1
11.3
1.1
18.2
0.3
32
13.4
2.5
100
2010
%
0.2
0.9
0.7
1.4
5.7
1.5
6
2.3
20.5
0.5
44
15.5
0.8
100
n
24
58
103
100
562
286
886
349
2449
121
5873
2837
66
13714
2006
n
5
36
75
190
593
63
422
115
959
100
2243
1185
101
6087
%
0.1
0.6
1.2
3.1
9.7
1
6.9
1.9
15.8
1.6
36.8
19.5
1.7
100
2011
%
0.2
0.4
0.8
0.7
4.1
2.1
6.5
2.5
17.9
0.9
42.8
20.7
0.5
100
n
22
126
62
184
756
214
713
318
3074
110
6955
3140
113
15787
2007
n
24
117
151
128
809
141
797
107
1530
94
4075
1440
64
9477
%
0.3
1.2
1.6
1.4
8.5
1.5
8.4
1.1
16.1
1
43
15.2
0.7
100
2012
%
0.1
0.8
0.4
1.2
4.8
1.4
4.5
2
19.5
0.7
44.1
19.9
0.7
100
n
32
185
87
133
989
256
811
296
3497
66
6979
4229
162
17722
2008
n
29
87
120
168
699
156
844
248
2009
101
5266
1784
125
11636
%
0.2
0.7
1
1.4
6
1.3
7.3
2.1
17.3
0.9
45.3
15.3
1.1
100
2013
%
0.2
1
0.5
0.8
5.6
1.4
4.6
1.7
19.7
0.4
39.4
23.9
0.9
100
n
47
96
112
142
937
368
1207
111
3698
99
8003
4442
251
19513
%
0.2
0.5
0.6
0.7
4.8
1.9
6.2
0.6
19
0.5
41
22.8
1.3
100
Table 11.2.6(a): Distribution of prescribed Kt/V, HD patients
2004-2013
Year
Number of
patients
Mean
SD
Median
LQ
UQ
% patients
≥ 1.3
% patients
≥ 1.4
2004
7456
1.6
0.4
1.6
1.4
1.9
82
72
2005
8748
1.6
0.4
1.6
1.4
1.9
81
72
2006
11091
1.6
0.4
1.6
1.3
1.8
78
67
2007
12354
1.6
0.4
1.6
1.3
1.9
78
68
2008
14755
1.6
0.4
1.6
1.4
1.8
80
70
2009
17258
1.7
0.4
1.6
1.4
1.9
83
74
2010
18726
1.7
0.4
1.6
1.4
1.9
81
72
2011
21470
1.7
0.4
1.6
1.4
1.9
83
75
2012
24710
1.7
0.4
1.7
1.4
2
84
76
2013
27846
1.7
0.4
1.6
1.4
1.9
82
73
Source: 21st MDTR Report 2013, NRR
Figure 11.2.6(a): Cumulative distribution of prescribed Kt/V,
HD patients 2004-2013
2005
2011
2007
2013
2009
Cumulative distribution
1
.75
.5
.25
0
1
1.2
1.4
1.6
1.8
KT/V
2
2.2
2.4
Source: 21st MDTR Report 2013, NRR
Table 11.2.6(b): Distribution of delivered Kt/V, HD patients
2009-2013
Year
Number of
patients
Mean
SD
Median
% patients
≥1.2
% patients
≥1.3
Variance
*
2009
10468
1.5
0.7
1.4
1.3 1.7
81
65
0.1
2010
11697
1.4
0.5
1.4
1.2 1.6
79
63
0.1
2011
13622
1.5
1.2
1.4
1.2 1.7
80
64
0.1
2012
15817
1.5
0.5
1.5
1.3 1.7
82
67
0.1
2013
18956
1.5
0.4
1.4
1.2 1.7
80
64
0.1
LQ
UQ
*Variance = (prescribed KT/V – delivered KT/V)/ Prescribed KT/V
Source: 21st MDTR Report 2013, NRR
Figure 11.2.6(b): Cumulative distribution of delivered Kt/V,
HD patients 2009-2013
2009
2010
2011
2012
2013
Cumulative distribution
1
.75
.5
.25
0
.8
1
1.2
1.4
1.6
1.8
2
2.2
KT/V
Source: 21st MDTR Report 2013, NRR
Table 11.2.6(c): Distribution of URR, HD patients 2009-2013
% patients ≥ % patients ≥
65%
70%
Year
Number of
patients
Mean
SD
Median
2009
14953
71
9
71.7
66.1 76.9
79
58
2010
16727
71.1
8.6
71.6
66.3 76.8
80
58
2011
19209
71.2
8.8
71.9
66.3
80
60
2012
22527
71.1
8.9
71.8
66.2 77.1
79
59
2013
25832
71.4
8.8
72.1
66.5 77.3
80
60
LQ
UQ
77
Source: 21st MDTR Report 2013, NRR
Figure 11.2.6 (c): Cumulative distribution of URR, HD
patients 2009-2013
2009
2010
2011
2012
2013
Cumulative distribution
1
.75
.5
.25
0
55
60
65
70
75
80
85
90
URR
Source: 21st MDTR Report 2013, NRR
Table 11.2.7(a): Variation in median blood flow rates in HD
patients, HD centres, 2004-2013
Year
Number of
centres
Min
5th
Centile
LQ
Median
UQ
95th
Centile
Max
2004
184
220
250
257.5
287.5
300
350
400
2005
228
200
250
260
300
300
350
400
2006
283
200
250
270
300
300
350
400
2007
302
200
250
280
300
300
350
400
2008
355
200
250
280
300
300
350
400
2009
404
180
250
280
300
320
350
400
2010
435
150
250
280
300
320
350
400
2011
495
200
250
300
300
330
350
400
2012
553
165
250
300
300
350
350
400
2013
600
140
250
300
300
347.5
370
400
Source: 21st MDTR Report 2013, NRR
Figure 11.2.7 (a): Variation in median blood flow rates in
HD patients among centres 2013
Median blood flow rate
(lower quartile, upper quartile)
Blood flow rate, ml/min
400
350
300
250
200
150
100
0
50
100
150 200
250
300 350
Centre
400
450
500
550
600
Source: 21st MDTR Report 2013, NRR
Table 11.2.7 (b): Proportion of patients with blood flow
rates ≥ 300 ml/min, HD centres 2004-2013
Year
Number of
Min
centres
5th
Centile
LQ
Median
UQ
95th
Centile
Max
2004
184
0
4
23.5
48.5
73
93
100
2005
228
0
0
28
53
77
94
100
2006
283
0
5
30
63
83
94
100
2007
302
0
7
37
68
84
96
100
2008
355
0
9
40
70
86
99
100
2009
404
0
11
42.5
72
88
99
100
2010
435
0
9
46
75
90
100
100
2011
495
0
14
55
77
91
100
100
2012
553
0
22
58
80
91
100
100
2013
600
0
23
59
79
92
100
100
Source: 21st MDTR Report 2013, NRR
Figure 11.2.7 (b): Variation in Proportion of patients with
blood flow rates >= 300 ml/min among HD centres 2013
% with blood flow rate >=300 ml/min
(lower 95% CI, upper 95% CI)
100
90
80
% patients
70
60
50
40
30
20
10
0
0
50
100 150 200 250 300 350 400 450 500 550 600
Centre
Source: 21st MDTR Report 2013, NRR
Table 11.2.7(c): Proportion of patients with 3 HD sessions
per week, HD centres 2004-2013
Min
5th
Centile
UQ
95th
Centile
LQ
Median
Max
188
37
70
98
100
100
100
100
2005
231
40
75
99
100
100
100
100
2006
287
52
83
98
100
100
100
100
2007
309
51
87
98
100
100
100
100
2008
359
51
89
98
100
100
100
100
2009
404
18
88
100
100
100
100
100
2010
437
20
90
100
100
100
100
100
2011
497
50
92
100
100
100
100
100
2012
559
17
90
98
100
100
100
100
2013
607
48
92
99
100
100
100
100
Year
Number of
centres
2004
Source: 21st MDTR Report 2013, NRR
% patients
Figure 11.2.7(c): Variation in proportion of patients with 3
HD sessions per week among HD centres 2013
% with 3 HD sessions per week
(lower 95% CI, upper 95% CI)
100
90
80
70
60
50
40
30
20
10
0
0
50
100 150 200 250 300 350 400 450 500 550 600
Centre
Source: 21st MDTR Report 2013, NRR
Table 11.2.7(d): Median prescribed Kt/V in HD patients, HD
centres 2004-2013
Min
5th
Centile
UQ
95th
Centile
LQ
Median
Max
181
1.2
1.4
1.5
1.6
1.7
1.9
2.2
2005
224
1.2
1.3
1.5
1.6
1.7
1.8
2
2006
281
1
1.3
1.4
1.6
1.7
1.8
2.1
2007
302
1.1
1.3
1.4
1.6
1.7
1.8
2.2
2008
353
1.1
1.3
1.5
1.6
1.7
1.9
2.1
2009
400
1.1
1.3
1.5
1.6
1.7
1.9
2.2
2010
434
0.8
1.3
1.5
1.6
1.7
1.9
2.9
2011
495
1.1
1.3
1.5
1.6
1.8
2
2.5
2012
552
1.1
1.4
1.5
1.7
1.8
2
2.8
2013
599
0.8
1.3
1.5
1.6
1.7
2
2.5
Year
Number of
centers
2004
Source: 21st MDTR Report 2013, NRR
Figure 11.2.7(d): Variation in median prescribed Kt/V in HD
patients among HD centres 2013
Median prescribed KT/V
(lower quartile, upper quartile)
3.5
3
KT/V
2.5
2
1.5
1
0
50
100 150 200 250 300 350 400 450 500 550 600
Centre
Source: 21st MDTR Report 2013, NRR
Table 11.2.7(e): Proportion of patients with prescribed Kt/V ≥ 1.3,
2004-2013
Min
5th
Centile
UQ
95th
Centile
LQ
Median
Max
181
28
58
74
83
91
98
100
2005
224
32
58
73
82
90.5
98
100
2006
281
0
46
68
80
88
97
100
2007
302
21
50
67
80
89
97
100
2008
353
14
48
69
84
90
98
100
2009
400
26
53.5
75
86
92
98
100
2010
434
6
50
74
85
91
100
100
2011
495
15
58
77
87
93
100
100
2012
552
29
58
77.5
86
93
100
100
2013
599
4
55
75
85
92
100
100
Year
Number of
centers
2004
Source: 21st MDTR Report 2013, NRR
Figure 11.2.7(e): Variation in proportion of patients with
prescribed Kt/V ≥ 1.3 among HD centres 2013
% with prescribed KT/V >=1.3
(lower 95% CI, upper 95% CI)
100
90
80
% patients
70
60
50
40
30
20
10
0
0
50
100 150 200 250 300 350 400 450 500 550 600
Centre
Source: 21st MDTR Report 2013, NRR
Table 11.2.7(f): Median delivered Kt/V in HD patients, HD
centres 2009-2013
Min
5th
Centile
LQ
Median
239
1
1.2
1.3
2010
253
0.8
1.1
2011
302
0.9
2012
355
2013
411
Year
Number of
centers
2009
UQ
95th
Centile
Max
1.4
1.5
1.6
2
1.3
1.4
1.5
1.6
2
1.2
1.3
1.4
1.5
1.7
2
1
1.2
1.3
1.5
1.5
1.7
2.2
0.6
1.2
1.3
1.4
1.5
1.7
2
Source: 21st MDTR Report 2013, NRR
Figure 11.2.7(f): Variation in median delivered Kt/V in HD
patients among HD centres 2013
Median delivered KT/V
(lower quartile, upper quartile)
2.4
2.2
2
KT/V
1.8
1.6
1.4
1.2
1
.8
.6
0
30
60
90
120 150 180 210 240 270 300 330 360 390 420
Centre
Source: 21st MDTR Report 2013, NRR
Table 11.2.7(g): Proportion of patients with delivered Kt/V ≥
1.2, HD centres 2009-2013
Min
5th
Centile
LQ
Median
239
18
51
74
2010
253
0
47
2011
302
6
2012
355
2013
411
Year
Number of
centers
2009
UQ
95th
Centile
Max
84
90
97
100
71
83
89
98
100
51
74
84
91
100
100
26
49
74
85
92
98
100
4
47
71
82
90
97
100
Source: 21st MDTR Report 2013, NRR
Figure 11.2.7(g): Variation in proportion of patients with
delivered Kt/V ≥ 1.2, HD centres 2013
% with delivered KT/V >=1.2
(lower 95% CI, upper 95% CI)
100
90
80
% patients
70
60
50
40
30
20
10
0
0
30
60
90 120 150 180 210 240 270 300 330 360 390 420
Centre
Source: 21st MDTR Report 2013, NRR
Table 11.2.7(h): Median URR among HD patients, HD
centres 2009-2013
Min
5th
Centile
LQ
Median
350
60
64.4
68.7
2010
397
54.6
64.8
2011
459
45.2
2012
523
2013
579
Year
Number of
centers
2009
UQ
95th
Centile
Max
71.8
74.1
77
93.3
69
71.3
73.8
76.7
94
64.8
68.8
71.7
74.3
77.9
96.8
56.3
65.2
68.7
71.8
74
77.5
96
59.6
64.6
68.8
71.7
74.4
77.9
95.2
Source: 21st MDTR Report 2013, NRR
Figure 11.2.7(h): Variation in median URR among HD
patients, HD centres 2013
Median URR
(lower quartile, upper quartile)
100
90
URR %
80
70
60
50
40
0
50
100
150
200
250
300 350
Centre
400
450
500
550
600
Source: 21st MDTR Report 2013, NRR
Table 11.2.7(i): Proportion of HD patients with URR ≥ 65%,
HD centres 2009-2013
Min
5th
Centile
LQ
Median
350
22
45
69
2010
397
13
48
2011
459
0
2012
523
2013
579
Year
Number of
centers
2009
UQ
95th
Centile
Max
81
89
97
100
69
82
90
98
100
50
70
82
91
100
100
17
50
69
81
89
98
100
23
50
70
81
91
98
100
Source: 21st MDTR Report 2013, NRR
Figure 11.2.7(i): Variation in proportion of patients with
URR ≥ 65% among HD centres 2013
% with URR >=65%
(lower 95% CI, upper 95% CI)
100
90
80
% patients
70
60
50
40
30
20
10
0
0
50
100
150
200
250
300 350
Centre
400
450
500
550
600
Source: 21st MDTR Report 2013, NRR
Table 11.3.1(a): Unadjusted technique survival by year of entry, 2004-2013
Year
Interval
(month)
0
6
12
24
36
48
60
72
84
96
108
120
Year
Interval
(month)
0
6
12
24
36
48
60
n
2745
2570
2375
2073
1791
1568
1370
1200
1035
893
787
2
n
4573
4274
3976
3439
2997
2638
62
2004
%
Survival
100
94
88
78
68
60
52
46
40
34
31
2009
%
Survival
100
94
88
76
67
59
SE
n
0
1
1
1
1
1
1
1
1
1
2959
2731
2524
2189
1930
1676
1459
1289
1109
958
9
SE
n.
0
0
1
1
1
4950
4501
4185
3620
3183
60
2005
%
Survival
100
93
87
76
68
59
52
46
39
34
2010
%
Survival
100
91
85
74
66
SE
n
0
1
1
1
1
1
1
1
1
3421
3143
2918
2562
2252
2004
1756
1542
1326
26
SE
n.
0
1
1
1
5633
5176
4799
4200
126
2006
%
Survival
100
93
87
77
68
61
53
47
40
2011
%
Survival
100
93
86
76
SE
n
0
1
1
1
1
1
1
1
3691
3464
3219
2827
2472
2151
1891
1656
30
SE
n
0
0
1
5996
5575
5226
148
2007
%
Survival
100
94
88
78
68
60
53
46
2012
%
Survival
100
94
88
SE
n
0
1
1
1
1
1
1
4207
3931
3674
3178
2793
2429
2121
62
SE
n
0
0
5737
2983
176
2008
%
SE
Survival
100
94
88
77
68
59
52
2013
%
Survival
100
95
0
1
1
1
1
1
SE
0
Source: 21st MDTR Report 2013, NRR
Figure 11.3.1(a): Unadjusted technique survival by year of
entry, 2004-2013
Kaplan-Meier survival estimates, by Year
1.00
Yr 13
Yr 12
Yr 11
0.75
Yr 10
Yr 09
Yr 08
0.50
Yr 07
Yr 06
Yr 05
Yr 04
0.25
0.00
0
12
24
36
48
60
72
Duration in months
84
96
108
120
Source: 21st MDTR Report 2013, NRR
Table 11.3.1(b): Unadjusted technique survival by year of
entry (censored for death & transplant), 2004-2013
Year
Interval
(month)
0
6
12
24
36
48
60
72
84
96
108
120
Year
Interval
(month)
0
6
12
24
36
48
60
n
2745
2570
2375
2073
1791
1568
1370
1200
1035
893
787
2
n
4573
4274
3976
3439
2997
2638
62
2004
%
Survival
100
100
100
99
99
98
97
97
96
96
95
2009
%
Survival
100
100
99
99
98
98
SE
n
0
0
0
0
0
0
0
0
0
1
2959
2731
2524
2189
1930
1676
1459
1289
1109
958
9
SE
n
0
0
0
0
0
4950
4501
4185
3620
3183
60
2005
%
Survival
100
100
99
99
99
98
98
97
97
96
2010
%
Survival
100
99
99
98
97
SE
n
0
0
0
0
0
0
0
0
0
3421
3143
2918
2562
2252
2004
1756
1542
1326
26
SE
n
0
0
0
0
5633
5176
4799
4200
126
2006
%
Survival
100
100
99
99
98
98
97
97
96
2011
%
Survival
100
99
99
98
SE
n
0
0
0
0
0
0
0
0
3691
3464
3219
2827
2472
2151
1891
1656
30
SE
n
0
0
0
5996
5575
5226
148
2007
%
Survival
100
100
99
99
98
98
97
96
2012
%
Survival
100
99
99
SE
n
0
0
0
0
0
0
0
4207
3931
3674
3178
2793
2429
2121
62
SE
n
0
0
5737
2983
176
2008
%
SE
Survival
100
100
0
99
0
99
0
98
0
98
0
97
0
2013
%
SE
Survival
100
99
0
Source: 21st MDTR Report 2013, NRR
Figure 11.3.1(b): Unadjusted technique survival by year of
entry (censored for death & transplant), 2004-2013
Kaplan-Meier survival estimates, by Year
1.00
Yr 13
Yr 12
Yr 11
Yr 10
Yr 09
Yr 08
Yr 07
Yr 06
Yr 05
Yr 04
0.75
0.50
0.25
0.00
0
12
24
36
48
60
72
Duration in months
84
96
108
120
Source: 21st MDTR Report 2013, NRR
Table 11.3.2(a): Unadjusted technique survival by age, 2004-2013
Age group (year)
Interval (month)
n
0
6
12
24
36
48
60
72
84
96
108
120
147
134
120
90
66
51
36
24
17
12
7
1
Age group (year)
Interval(month)
0
6
12
24
36
48
60
72
84
96
108
120
n
10793
9552
8352
6364
4750
3441
2453
1673
1025
516
223
2
≤ 14
%
Survival
100
94
89
79
75
69
65
63
60
60
53
45-54
%
Survival
100
95
89
80
73
65
59
53
46
40
37
SE
n
2
3
4
4
4
5
5
6
6
9
1200
1087
958
765
619
501
381
293
197
121
59
1
15-24
%
Survival
100
96
93
88
84
83
81
78
75
73
71
SE
n
0
0
0
0
1
1
1
1
1
1
13194
11470
9812
7112
5002
3435
2298
1483
865
451
156
1
SE
n
1
1
1
1
1
1
2
2
2
2
2734
2457
2146
1693
1334
1020
757
540
360
217
105
1
55-64
%
Survival
100
93
87
76
65
56
48
41
34
28
22
25-34
%
Survival
100
96
93
88
85
81
77
74
71
69
67
SE
n
0
1
1
1
1
1
1
1
1
2
4752
4254
3702
2872
2257
1735
1306
916
615
355
168
1
SE
n
0
0
0
0
1
1
1
1
1
1
11092
9388
7804
5335
3513
2290
1398
815
420
191
79
1
35-44
%
Survival
100
95
91
84
79
75
70
65
60
56
52
≥ 65
%
Survival
100
90
82
68
55
44
35
27
20
15
12
SE
0
0
1
1
1
1
1
1
1
1
SE
0
0
0
1
1
1
1
1
1
1
Source: 21st MDTR Report 2013, NRR
Figure 11.3.2(a): Unadjusted technique survival by age,
2004-2013
Kaplan-Meier survival estimates, by Age
1.00
0.75
Age 15-24
Age 25-34
Age 1-14
Age 35-44
0.50
Age 45-54
0.25
Age 55-64
Age>=65
0.00
0
12
24
36
48
60
72
84
96
Duration in months
108 120 132 144
Source: 21st MDTR Report 2013, NRR
Table 11.3.2(b): Unadjusted technique survival by age (censored for
death & transplant), 2004-2013
Age group (year)
Interval
(month)
0
6
12
24
36
48
60
72
84
96
108
120
Age group (year)
Interval
(month)
0
6
12
24
36
48
60
72
84
96
108
120
n
147
134
120
90
66
51
36
24
17
12
7
1
n
10793
9552
8352
6364
4750
3441
2453
1673
1025
516
223
2
≤ 14
%
Survival
100
98
95
91
90
90
90
90
90
90
90
45-54
%
Survival
100
100
99
99
98
98
97
97
96
96
95
SE
n
1
1200
1087
2
3
3
3
3
3
3
3
3
958
765
619
501
381
293
197
121
59
1
15-24
%
Survival
100
99
98
97
97
96
96
96
96
96
96
SE
n
0
0
0
0
0
0
0
0
0
1
13194
11470
9812
7112
5002
3435
2298
1483
865
451
156
1
SE
n
0
2734
2457
0
0
1
1
1
1
1
1
1
25-34
%
Survival
100
99
2146
1693
1334
1020
757
540
360
217
105
1
55-64
%
Survival
100
99
99
98
98
97
97
95
95
94
93
99
98
98
97
97
96
95
95
95
SE
n
0
4752
4254
0
0
0
0
0
1
1
1
1
SE
n
0
0
0
0
0
0
0
0
1
1
11092
9388
7804
5335
3513
2290
1398
815
420
191
79
1
3702
2872
2257
1735
1306
916
615
355
168
1
35-44
%
Survival
100
99
SE
0
99
99
98
98
97
97
96
96
95
≥ 65
%
Survival
100
99
99
98
98
97
96
96
96
95
95
0
0
0
0
0
0
0
1
1
SE
0
0
0
0
0
0
0
0
1
1
Figure 11.3.2(b): Unadjusted technique survival by age
(censored for death & transplant), 2004-2013
Kaplan-Meier survival estimates, by Age
Age 15-24
Age 25-34
1.00
Age 35-44
Age 45-54
Age 55-64
Age>=65
Age 1-14
0.75
0.50
0.25
0.00
0
12
24
36
48
60
72
Duration in months
84
96
108
120
Source: 21st MDTR Report 2013, NRR
Table 11.3.3(a): Unadjusted technique survival by diabetes
status, 2004-2013
Non-Diabetic
Diabetes status
Interval (month)
n
% Survival
0
17699
100
6
15544
94
12
13567
24
Diabetic
SE
n
% Survival
SE
26213
100
0
22795
93
0
89
0
19326
86
0
10455
81
0
13774
74
0
36
7917
75
0
9623
63
0
48
5922
69
0
6539
53
0
60
4317
64
0
4277
45
0
72
3020
59
1
2723
38
0
84
1980
54
1
1518
30
0
96
1146
50
1
704
24
1
108
519
47
1
270
20
1
120
2
2
Source: 21st MDTR Report 2013, NRR
Figure 11.3.3(a): Unadjusted technique survival by
diabetes status, 2004-2013
Kaplan-Meier survival estimates, by Diabetes
Cumulative survival
1.00
0.75
Non-diabetic
0.50
Diabetic
0.25
0.00
0
12
24
36
48
60
72
84
Duration in months
96
108
120
Source: 21st MDTR Report 2013, NRR
Table 11.3.3(b): Unadjusted technique survival by diabetes
status (censored for death & transplant), 2004-2013
Diabetes status
Interval (month)
Non-Diabetic
n
% Survival
0
17699
100
6
15544
99
12
13567
24
Diabetic
SE
n
% Survival
SE
26213
100
0
22795
99
0
99
0
19326
99
0
10455
98
0
13774
98
0
36
7917
98
0
9623
98
0
48
5922
98
0
6539
97
0
60
4317
97
0
4277
97
0
72
3020
97
0
2723
96
0
84
1980
96
0
1518
95
0
96
1146
96
0
704
94
0
108
519
95
0
270
94
1
120
2
2
Source: 21st MDTR Report 2013, NRR
Figure 11.3.3(b): Unadjusted technique survival by diabetes
status (censored for death & transplant), 2004-2013
Kaplan-Meier survival estimates, by Diabetes
1.00
Non-diabetic
Cumulative survival
Diabetic
0.75
0.50
0.25
0.00
0
12
24
36
48
60
72
84
Duration in months
96
108
120
Source: 21st MDTR Report 2013, NRR